Presentation on theme: "Safeguarding Children STEPP Unit 1 Regional Programme October 2014."— Presentation transcript:
Safeguarding Children STEPP Unit 1 Regional Programme October 2014
Objectives To be aware of the indicators of Abuse & Neglect Understand the impact of family stressors on the welfare of children To raise awareness of the importance of multi agency working To gain basic understanding of the Legal Framework in relation to Children The importance of listening to children
LEGAL FRAMEWORK The Framework for Assessment for Children 2000 National Service Framework for Children’s Services 2004 Children Act 1989/2004 Working Together 1999/2006/2013 Rotherham Safeguarding Board Child Protection 2013 Procedures
‘, ‘SAFEGUARDING’, A duty to protect from maltreatment & Impairment Ensuring children are growing up in circumstances consistent with the provision of safe and effective care that enables children to have optimum life chances [WTSC 2013]
CHILD PROTECTION Is part of safeguarding and promoting welfare. Refers to the activity that is specifically undertaken to protect specific children who are suffering or at risk of suffering significant harm as a result of abuse or neglect. [ WTSC 2013]
CHILDREN IN NEED Children are defined as in need under the Children Act 1989 [S17], as those whose vulnerability is such that they are unlikely to reach or maintain a satisfactory level of health and development, or their health and development will be significantly impaired without the provision of services. This will include disabled children.
HARM SIGNIFICANT HARM The Children Act 1989 [S47] introduced this concept as the threshold that justifies compulsory intervention in family life. Can be single or multiple events, which interrupt, change or damage a child's physical and psychological development.
Indicators of Abuse & Neglect- A Case Study
Scenario A 3 ½ year old attends the ED at 20:30 hours, with a swollen and painful left arm. Mum states he fell from the settee yesterday morning. He also had numerous other bruises. He appears pale and quiet.
What are your thoughts? Do you have concerns? What next?
Gathering and sharing information D/W paeds/orthopods Admit child Child Protection medical Health Visitor GP Social Care Police Nusery information Strategy meeting…
Further information… Mum -significant domestic abuse with several partners, (as victim and perpetrator) numerous police attendances, weapons used, i.e. knives Maternal mental ill health-prev suicide attempts Parental alcohol misuse Several house moves Child thin, hungry and scavenging for food at school Other siblings previously presented with concerning injuries
Child Protection Medical Spiral fracture left humerus Many bruises not explained by normal play- therefore unexplained Significantly malnourished Discussion
Themes from Serious Case Reviews Voice of the child not heard-not being spoken to in their own language and alone Domestic abuse minimised by all agencies Alcohol misuse and mental health issues unassessed by relevant professionals. Rule of Optimism prevailed, the significant injury too readily accepted as accidental. Invisible men Balance of probabilities Resistant families –Disguised Compliance
Physical Abuse Physical abuse may involve hitting, shaking, throwing, poisoning, burning or scalding, drowning, suffocating, or otherwise causing physical harm to a child. Physical harm may be caused when a parent or carer fabricates the symptoms of, or deliberately induces illness in a child. Working Together to Safeguard Children DCFS 2013
Possible Indicators Physical Bruises: To the eyes, mouth or ears Finger tip bruising (grasp marks) Bruises of different ages in the same place Outline bruises (prints of hands, belts, shoes etc) Bruises without obvious and verifiable explanations Bruises to non-mobile babies (consider the possibility of shaking)
Possible Indicators (cont) Burns, bites and scars: Clear impressions of teeth (if more than 3cm across, they are unlikely to have been made by a child) Burns or scalds with clear outlines Small round burns which may be from cigarettes Large numbers of different aged scars Unusually shaped scars Scars that indicate that the child did not receive medical treatment
Possible Indicators (cont) Fractures Fractures in children under one year of age Allegedly unnoticed fractures Other injuries: Poisoning, injections, ingestion or other application of dangerous substances (including drugs and alcohol) Female genital mutilation, including female circumcision. Signs of shaking including: -any bruising to a young baby – particularly the trunk/ arms/ face -facial petechiae
Impact of Physical abuse Neurological damage Physical injuries Disability Death Linked to: Aggressive behavior Emotional and behavioral difficulties Educational difficulties
History is incompatible with injury type History of how the injury occurred is vague History changes each time it is told to a different health care worker Parents, when interviewed separately, give contradictory histories History is not credible, actions are not age appropriate Historical Indicators
There is often a significant delay between the time of injury and the time of presentation The parent may not show the degree of concern appropriate to the severity of the child’s injury A pathological parent/child interaction is observed. Unrealistic expectations, inappropriate demands, angry impulsive behaviour Behavioural Indicators
Sexual Abuse Sexual abuse involves forcing or enticing a child or young person to take part in sexual activities, not necessarily involving a high level of violence whether or not the child is aware what is happening. The activities may involve physical contact including assault by penetration (for example, rape, or oral sex) or non-penetrative acts such as masturbation, kissing, rubbing and touching outside of clothing. They may also include non-contact activities, such as involving children in looking at, or in the production of sexual images, watching sexual activities, or encouraging children to behave in sexually inappropriate ways, or grooming a child in preparation for abuse ( including via the internet). Sexual abuse is not solely perpetrated by adult males. Women can also commit acts of sexual abuse, as can other children. Working Together to Safeguard Children DCSF 2013
Possible Indicators Sexual Abuse Sexually-transmitted infections Hidden/Unexplained pregnancy Recurrent urinary infections Genital and rectal soreness Unexplained bleeding and discharges Bruising in the genital region masturbation that is judged to be inappropriate to a child’s age, development and circumstances Sexual play Sexually explicit behaviour Sexual knowledge inappropriate to the age of the child Sexually abusive behaviour towards other children, particularly those younger or more vulnerable than themselves NO INDICATION OR DISCLOSURE
Impact of Sexual Abuse Effects of pregnancy or sexually transmitted infections Low self esteem Depression and suicide Coping with secrecy Educational and social difficulties
CSE Child Sexual Exploitation The sexual exploitation of children and young people (CSE) under-18 is defined as that which: ‘involves exploitative situations, contexts and relationships where young people (or a third person or persons) receive ‘something’ (e.g. food, accommodation, drugs, alcohol, cigarettes, affection, gifts, money) as a result of them performing, and/or another or others performing on them, sexual activities. Child sexual exploitation can occur through the use of technology without the child’s immediate recognition; for example being persuaded to post sexual images on the Internet/mobile phones without immediate payment or gain. In all cases, those exploiting the child/young person have power over them by virtue of their age, gender, intellect, physical strength and/or economic or other resources. Violence, coercion and intimidation are common, involvement in exploitative relationships being characterised in the main by the child or young person’s limited availability of choice resulting from their social/economic and/or emotional vulnerability’ (Department for Education 2012 )
Important aspects to consider Sexual exploitation occurs in a social context of violence towards women. However boys and young men can be exploited too. Abusers coercers often physically, emotionally and sexually abuse children and young people and I some cases may imprison them. Because of either their age or their needs, children and young people are unable to give truly informed consent to relationships and sexual activity Children and young people do not make informed choices to enter or remain in sexually exploitation but do so due to coercion, enticement manipulation of desperation Young people under the age of 16 cannot legally give consent to sexual activity Sexual intercourse with a child under the age of 13 is statutory rape
Potential Indicators of Sexual Exploitation Unaccountable gifts/monies Experimenting with drugs and alcohol Reduced contact with family and friends Changes in behaviour/friendship groups Coming home late/going missing Older boyfriend STI's repeat attendances at sexual health services Internet grooming Getting into cars with unknown males Sexual activity at an early age Unexplained injuries
Factors heightening the risk of CSE Children in Care Early CP concerns Previous sexual abuse Family bereavement Family alcohol use Substance misuse Poor school attendance Peers being exploited Homelessness Domestic violence Previous abuse Dysfunctional family Male domination Poverty Learning disabilities Learning difficulties Gang association
Enforcing the CSE Gifts- drugs/alcohol Promoting dependence on substances Fear Mobile top ups False promises of physical and emotional abuse Threats to family members ALWAYS A POWER IMBALANCE, PERPETRATORS ALWAYS HAVE CONTROL OVER THEIR VICTIMS
Sexual Exploitation Team Receive referrals from the CART Team Based at PPU Maltby Dedicated team who offer support is Social Care Manager Claire Edgar Qualified Social Workers Parent Support Worker Dedicated Police Officers Link closely to health professionals
SARC A service where female and male victims of rape and sexual assault can receive medical care and counselling all under one roof. The service takes self-referrals or referrals can be made through other services such as the police. Telephone: The Isis, Rotherham NHS Foundation Trust, Moorgate Road, Rotherham, S60 2UD.
Children's Independent Sexual Violence Advisor (CISVA) Police bring children to centre for examination following an allegation Referral is made to CISVA CISVA provides holistic support to the child and their family to assist and guide them through any legal processes and help them access relevant support services
Neglect Neglect is the persistent failure to meet a child’s basic physical and/or psychological needs, likely to result in the serious impairment of the child’s health or development. Neglect may occur during pregnancy as a result of maternal substance abuse. Once a child is born, neglect may involve a parent or carer failing to: provide adequate food, clothing and shelter including exclusion from home or abandonment. protect a child from physical and emotional danger; ensure adequate supervision (including the use of inadequate care givers); or ensure access to appropriate medical care or treatment. May also include neglect or unresponsiveness to a child’s basic emotional needs. Working Together to Safeguard Children DCSF 2013
Possible Indicators Neglect Children who are: Not receiving adequate food, emotional warmth, supervision or stimulation. Exposed to inadequate, dirty / cold environments Prevented by their carers from receiving appropriate medical advice or treatment
Impact of Neglect Impairment of growth Impairment of intellectual development Death Long-term difficulties with : Social functioning Relationships Educational progress.
EMOTIONAL ABUSE The persistent ill-treatment of a child such as to cause severe and persistent adverse effects on the child’s emotional development. It may involve conveying to children they are worthless, unloved in adequate or valued only insofar as they meet the needs of another person. It may include not giving the child opportunities to express their views, deliberately silencing them or ‘making fun’ of what they say or how they communicate. It may feature age or developmentally inappropriate expectations being placed on children. Working Together to Safeguard Children DCSF 2013
Emotional Abuse Cont These may include interactions that are beyond the child’s developmental capacity, as well as overprotection and limitation of exploration and learning, or preventing the child participating in normal social action. It may involve seeing or hearing the ill treatment of another. it may involve serious bullying (including cyber bullying) causing children frequently to frightened or in danger, or the exploitation or corruption of children. Some level of emotional abuse is involved in all types of maltreatment of a child, though it may occur alone. Working Together to Safeguard Children DCSF 2013
Possible Indicators Emotional Abuse Abnormally passive, lethargic, withdrawn or attention- seeking behaviour Specific habit disorders, e.g. faecal smearing, excessive drinking, eating unusual substances and self harm Severely delayed social development, poor language and speech development not otherwise explained Excessively nervous behaviour such as rocking or hair twisting Low self esteem
Impact of Emotional Abuse -Long-term consequences for children's development -Impacts on a developing child's mental health, behavior and self- esteem. -It can be especially damaging in infancy.
CONSENT/CONFIDENTIALITY Best practice to inform parents/carers what your concerns are and that a referral to social care is to be made UNLESS You will impair a criminal investigation Suspect fabricated or induced Illness Suspect sexual abuse You are concerned for the child’s or your own safety Consent not necessary to share information if the child is at risk of significant harm.
Factors influencing parenting capacity Mental Health Problems Substance Misuse Domestic Abuse Learning Difficulties Family and Environmental Factors Racism
Parental mental health issues One in four adults will experience a mental illness in their lifetime. Of these, between a quarter and a half will be parents. Their dependent children are at greater risk of experiencing health, social and/or psychological problems. Combined issues such as genetic inheritance, social adversity and psychological factors may lead to an increased chance of children experiencing mental health issues.
The impact of mental ill health on parental capacity will depend on the parent’s personality, the type of mental illness, its severity, the treatment given and support provided. Many mental health problems are manifested in intermittent episodes of symptoms. This can result in fluctuations between good and poor parental capacity. Parental mental health issues
Parental Substance Misuse Research carried out to inform the Advisory Council on the Misuse of Drugs report, ‘Hidden Harm’ (2003), estimated: –200, ,000 children of problem drug users in England and Wales –this represents 2-3% of children less than 16 years. Between 780,000 and 1.3 million children are affected by parental alcohol use in England and Wales (Harwin et al. 2009).
Parental Substance Misuse Parents report effects on: –providing a daily structure. –being consistent. –managing their children’s anger. –coping with children’s transition into adolescence, especially if it involves experimentation with drugs. –generally perceiving difficulties rather than positives in child’s behaviour. (Coleman and Cassell, 1995)
Domestic abuse 26% children and young people report physical violence in childhood: – 47% physical assaults – 13% used object or weapon 5% violence frequent. £23 billion per annum (England and Wales). More than 90% of domestic abuse is committed by men against women. Approximately 10% to 50% of women have been physically abused by an intimate male partner. UK statistics indicate that one in four women is likely to suffer domestic abuse.
Domestic abuse The impact on parental capacity can manifest in: lack of emotional warmth emotional unavailability inconsistent or unpredictable care environment pre-occupation with the intimate relationship increased levels of irritability, hostility, rejection and aggression increased risk of parental mental ill-health and substance misuse physical exhaustion and low self-esteem increased likelihood of anxiety and social exclusion.
MARAC Multi Agency Risk Assessment Conference Multi agency approach to support victims of domestic violence Previously 18yrs+ Now National pilot scheme 16/17yrs
LEARNING DISABILITES Can be wide ranging Accurate assessment of effects and impact upon parenting capacity essential Family/ professional support? Use of accessible, appropriate information Assessment of capacity should be considered to ensure appropriate service provision
Racism Institutionalised Community Experiences Should be explicitly considered in assessment process Lack of appropriate service provision Need for robust interpretation policy
Points to remember Beware of the Rule of Optimism Do not believe all you are told without evidence Always consider motivation of parents to change Consider family history of ability to change Chronologies are useful
Record Keeping Be diligent in your record keeping Be clear and factual If sharing a professional opinion be clear about this Record where you gained information from - - who told you what and when Records should be contemporaneous